Plasma concentrations of progesterone are higher in the uterine artery than in the radial artery after vaginal administration of micronized progesterone in an oil-based solution to postmenopausal women

Ettore Cicinelli; Mauro Cignarelli; Sergio Sabatelli; Francesco Romano; Luca Maria Schonauer; Rossella Padovano; Niels Einer-Jensen

doi:10.1016/s0015-0282(97)00545-1

Reproductive Endocrinology Ovarian Hormones

Plasma concentrations of progesterone are higher in the uterine artery than in the radial artery after vaginal administration of micronized progesterone in an oil-based solution to postmenopausal women

Cicinelli E, Cignarelli M, Sabatelli S, Romano F, Schonauer LM, Padovano R, Einer-Jensen N

Published March 1998 Fertility and Sterility, 69(3), 471-473

DOI 10.1016/s0015-0282(97)00545-1 PMID 9531879

RRM Academy Synopsis

Vaginal progesterone reaches the uterine artery at about twice the arm level

Postmenopausal women had about twice as much progesterone in the uterine artery as in an arm (radial) artery after one vaginal dose. Blood came from both sites at the same time. The prospective study covered 20 women who had hysterectomy. The authors call the result the "first uterine pass effect."

Key Findings

Twenty postmenopausal women, mean age 57 years (range 50 to 62), had hysterectomy for prolapse or pelvic floor repair, and blood was drawn during the operation.
Progesterone in uterine artery plasma was significantly higher than in paired radial artery plasma (P<0.000001).
The authors describe uterine artery progesterone as "about twice as high" as radial artery progesterone.
The authors conclude that the vaginal route sends progesterone selectively toward the uterus.

Interpretation

This cohort study followed 20 postmenopausal women who got one vaginal progesterone dose before hysterectomy. Each woman served as her own comparison between the uterine artery and the radial artery. The authors propose local transfer between vessels as the cause of this first uterine pass effect. The findings support larger studies of vaginal progesterone and how well it reaches the uterus.

RRM Context

Restorative reproductive medicine looks for the cause of low progesterone. Clinicians also ask how progesterone reaches the uterus. The authors cite earlier work by Miles and colleagues: uterine tissue levels ran higher after vaginal dosing than after injection, despite lower blood levels. This paper suggests a reason blood levels can understate what the uterus receives.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objective

To verify the occurrence of preferential distribution of vaginally administered progesterone to the uterus compared with extrapelvic regions in vivo and in humans.

Design

Prospective clinical study.

Setting

University medical school.

Patients

Twenty postmenopausal women undergoing transabdominal hysterectomy for benign pathologies.

Interventions

Forty-five minutes before surgery, the women received a single vaginal administration of an oil-based micronized progesterone (100 mg) solution currently available on the market for IM use. During the operation, parallel blood samples were drawn from the uterine and radial arteries.

Main Outcome Measures

Plasma levels of progesterone were measured by RIA.

Results

Mean (+/- SD) plasma levels of progesterone were significantly higher in the uterine artery than in the radial artery (9.75 +/- 3.21 vs. 5.12 +/- 2.06 ng/mL, respectively).

Conclusions

Vaginal administration allows a preferential distribution of progesterone to the uterus, which confirms the existence of the so-called "first uterine pass effect."

Topics

Reproductive Endocrinology › Ovarian Hormones › Progesterone · Therapeutics › Hormonal Agents › Progesterone and Progestins

Ettore Cicinelli, Mauro Cignarelli, Sergio Sabatelli, Francesco Romano, Luca Maria Schonauer, Rossella Padovano, Niels Einer-Jensen

E Cicinelli, M Cignarelli, S Sabatelli, F Romano, L Schonauer, R Padovano, N Einer-Jensen

PMID 9531879 9531879 DOI 10.1016/s0015-0282(97)00545-1 10.1016/s0015-0282(97)00545-1 Cicinelli et al. 1998, Cicinelli 1998

Keywords

Administration, Intravaginal, Arteries, Female, Humans, Middle Aged, Postmenopause, Progesterone/administration & Dosage/blood, Prospective Studies, Radial Artery, Solutions, Uterus/blood Supply, Solutions, Progesterone

Plasma concentrations of progesterone are higher in the uterine artery than in the radial artery after vaginal administration of micronized progesterone in an oil-based solution to postmenopausal women

Vaginal progesterone reaches the uterine artery at about twice the arm level

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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Keywords